Testosterone use does not increase cardiovascular risks
A significant association between exogenous testosterone treatment and cardiovascular events such as myocardial infarction (MI), stroke or mortality is lacking, according to the results of a systematic review and meta-analysis.
“However, it is essential to keep in mind the possibility of the risk being dose dependent or higher in certain groups such as the elderly,” said researchers. “The very low quality of the evidence precludes definitive conclusion on the cardiovascular effects of testosterone.”
In this review, 39 randomized controlled trials (RCTs) and 10 observational studies that enrolled men (aged ≥18 years) receiving exogenous testosterone for 3 or more days were included. Data from 30 RCTs were used for the meta-analysis.
Death due to all causes, stroke and MI were the primary outcomes, while secondary outcomes included other hard clinical effects such as heart failure, arrhythmia and cardiac procedures. Researchers assessed bias risk using Cochrane Collaboration tool and Newcastle and Ottawa scale, respectively. They evaluated evidence strength using the Grades of Recommendation, Assessment, Development, and Evaluation Working Group approach.
Exogenous testosterone treatment, compared with placebo, did not significantly increase the risk of MI (odds ratio [OR], 0.87; 95 percent CI, 0.39 to 1.93; 16 RCTs), stroke (OR, 2.17; 0.63 to 7.54; 9 RCTs) or mortality (OR, 0.88; 0.55 to 1.41; 20 RCTs). Observational studies revealed distinct clinical and methodological heterogeneity.
The evidence had very low quality rating due to the high risk of bias, imprecision and inconsistency, according to researchers.
An additional RCT after the report was completed showed comparable numbers of MI, stroke and deaths between the testosterone group (n=10) and placebo group (n=13) among 790 elderly men with age-onset hypogonadism.
“Similarly, a recently published observational study [found] that short-term exposure (median duration 2 months) to testosterone increased the hazard of mortality (HR, 1.11; 1.03 to 1.20) and cardiovascular events (HR, 1.26; 1.09 to 1.46),” they added.